Dr. Lai began teaching at ACTCM toward the latter half of the year when we had finished studying theory and moved on to application. Even though his English was barely intelligible, it was evident to everyone that he was an exceptional TCM clinician. Dr. Lai was in his early thirties, and it was amazing that such a youthful Chinese doctor had the depth of knowledge and experience usually seen only in much older individuals. In fact, many patients meeting Dr. Lai for the first time mistook him for the son of the esteemed doctor.
He was born in Canton in 1947. With the Communist takeover of China in 1949, Dr. Lai was stranded in Canton with his grandmother while his parents were in Hong Kong. When he turned twelve, his grandmother became ill. Fate dictated that he grow up quickly since he bore the responsibility of taking his grandmother to see doctors. While seeking a cure for her illness, he developed a keen interest in medicine. Concurrently, the political upheaval leading to the disastrous Cultural Revolution was brewing. By the time he was fifteen, the Cultural Revolution brought Dr. Lai’s formal schooling to an abrupt halt. From then on, he began a program of self-education in medicine. He bought books, studied in libraries, and sought out practical training from noted TCM practitioners. He applied what he learned by treating the sick and poor in surrounding villages. Often he had to devise treatments from the limited resources at hand. In 1970, at the age of twenty-three, he made his escape from China, swimming across the short stretch of water between Canton and Hong Kong. Two years later, he immigrated to the United States and helped his entire family to immigrate. By the time he was thirty-four and teaching at ACTCM, he already had twenty years of clinical experience.
I was one of a handful of students to whom Dr. Lai extended an open invitation to observe how he treated patients in his office. This was the opportunity of a lifetime. There was just one glitch. Since I am Cantonese, Dr. Lai preferred speaking to me in Cantonese, but my vocabulary was that of a grade school student. I understood only about 60 percent of what he said. Now I really regretted my inattention in Chinese school. Remembering how to say “The little cat jumped and jumped and jumped” from Book One, Lesson One was just not enough.
In addition to the Chinese language barrier, there was also the TCM language barrier. When Dr. Lai explained, “Now this is a Lung disease, and we know we have to calm the Liver and support the Spleen to help the Lung,” I would say to myself, What in the world do the liver and spleen have to do with treating the lung? I just nodded deferentially. When Dr. Lai used his broken English to explain disease processes and treatment principles, using TCM terminology, to his Caucasian patients, it was obvious that they could not understand a word of what he said either. They too nodded deferentially.
The pungent smell of herbs permeated Dr. Lai’s office—his wife packaged uncooked ones for some patients and boiled some on a hot plate for other patients who needed this service. On the walls hung plaques given by grateful patients extolling his abilities as a healer. The waiting room also served as the pharmacy. Patients sat waiting either to be seen or to pick up the herb prescription being filled by Mrs. Lai after the doctor had seen them. As Mrs. Lai filled prescriptions, friends and family would drop in to chat, giving the office a mom-and-pop family atmosphere.
Cubicles, just large enough for an acupuncture table and a portable electric heater, made up his treatment rooms. For privacy, a curtain separated the entry to each cubicle from the hallway. A large desk sat in the center of the consultation room. On the desk was a little pillow on which patients could rest their wrist for pulse taking. A blood pressure apparatus sat alongside the pillow, bespeaking Dr. Lai’s openness to Western medicine. A bookcase stood behind the desk where, among other books, there was a Chinese-English medical dictionary, which I found of immense help when communicating with Dr. Lai.
Other objects on the bookcase were evidence of Dr. Lai’s syncretism. A statue of Kwan-Yin, the Chinese goddess of mercy, stood on the top shelf, a statue of Christian praying hands graced the shelf below Kwan-Yin, and an “I’m for Nixon” campaign button was propped against the praying hands. As a boy, Dr. Lai had been quite ill. He had prayed to Kwan-Yin, and was healed. Although he could not accept that Jesus was the only way to salvation, he considered Jesus Christ too great not to be acknowledged. “What about Nixon?” I asked. “It was Nixon’s immigration policy that allowed refugees from Communist China to come to the United States,” he answered. This enabled him to immigrate in 1972.
Dr. Lai has an ebullient personality. He is a man with a big voice and a big heart. I have seen him waive fees for some patients who were in financial straits and take the same patients out to dinner on their birthdays. He loved to converse about a wide range of topics: medicine, philosophy, world affairs, and the economy, to name a few. Often deep in discussion, he would be oblivious of the time. His wife would have to run into the consultation room to remind him there were patients waiting. Unusual for a TCM practitioner, he is very receptive to Western medicine and reads extensively about it. He is not opposed to surgery or cancer chemotherapy but works with patients to supplement their Western treatment with herbal therapy. In the spirit of Louis Pasteur, Dr. Lai is a pioneer. He experimented with herbs, using himself as the test subject.
Dr. Lai’s clinical acumen is uncanny. Once when he was treating a patient with a stroke that had left the patient’s body half paralyzed, he asked me to order a test to check for the carotid artery blood flow to the part of the brain controlling the non-paralyzed side. From his pulse diagnosis, he determined that this artery was blocked. Indeed, the carotid ultrasound showed critical narrowing of the carotid artery on the side Dr. Lai had suspected.
A woman saw him for chronic upper back and chest pain that, despite myriad testing, had defied Western diagnosis. Dr. Lai sat at his desk, looked at the patient, and saw that one collarbone was higher than the other. With that observation, he was able to diagnose that the cause of her pain was a misalignment in her upper back, which he treated with acupuncture; her pain resolved.
Whenever I visited his office, Dr. Lai had me sit at the desk with him, and he introduced me to each patient. The English-speaking patients appreciated my presence. I served as interpreter, not only of the language, but also of any lab or X-ray results they brought to the office. On each patient, he would point out the subtle nuances in the feeling of the pulse and the appearance of the tongue to me. Next, he would teach the TCM diagnosis and then the treatment principle. Finally, with lightning speed, he wrote out his herbal prescription, using cursive script that only his wife could read, while simultaneously naming the herbs aloud. When it came to illegible handwriting, Western doctors had nothing on Dr. Lai. I had to take notes at a breakneck pace. Since he named the herbs in Chinese, I developed my own phonetic shorthand to keep up. Gradually I learned to write the Chinese characters for the herbs.
Despite his profound grasp of TCM, Dr. Lai also avidly read Chinese translations of Western medical literature. A woman who had suffered from infertility, on becoming pregnant after receiving TCM treatments, asked him about all the dos and don’ts during her pregnancy. He went on and on with advice, which sounded to me like Chinese folklore, such as, “Avoid going to the zoo so that your baby won’t come out looking like a monkey.” Then she asked, “What should I do to make sure my baby is smart?” He answered, “Oh, that’s in the genes, nothing you can do about that.”
Support the Host as well as Fight the Invader
In late 1981, when I began studying with Dr. Lai, the HIV-AIDS epidemic, which at the time still lacked a name, was underway in the United States. Often, desperately sick people who had exhausted Western methods came to seek his help. I had the opportunity to see exotic cases I had only read about in medical texts. It was in this setting that I learned the essential TCM treatment principle: when treating a foreign invader such as a virus or bacteria, use not only cleansing herbs, comparable to the Western antibiotic or antiviral, aimed at destroying the invader, but simultaneously support the host’s own ability to fight the invader with immune-boosting herbs. Early in the HIV-AIDS epidemic, before antiretroviral drugs were developed, what Western doctors learned was that no matter how potent the drugs, if the host immune system was nonfunctioning, recovery was hopeless. Since the HIV-AIDS epidemic, Western medicine began exploring the concept of immune modulation, a concept that has long been part of TCM.
The same principle applied to building up a host’s defense mechanisms when treating cancer patients. For these people, during radiation and chemotherapy, Dr. Lai would use herbs to treat the side effects, such as bone marrow depression, nausea, and fatigue. When the radiation and chemotherapy sessions ended, he would begin treatments with cleansing, anti-cancer type herbs, which he balanced with immune-boosting herbs. Finding the appropriate balance, the proportion of cleansing to tonifying herbs for a particular patient, is the challenge every TCM practitioner faces. To gain mastery over this art was my goal as Dr. Lai’s student and mentee.
Economics of Energy
The concept I call the economics of energy is key in the TCM approach to understanding health and disease. Dr. Lai used a metaphor to explain it: “You have only so much money in the bank, and you can’t keep spending more than you have.” Each one of us has a finite supply of energy. When the energy is adequate for all our bodily requirements, we remain healthy. When extra demand is put on our bodies from various causes such as stress, infection, trauma, lack of sleep, or change in diet, sometimes supply cannot keep up with demand, and the weakest link gives way.
A research study into the effects of increasing the temperature in operating rooms demonstrates this principle (Kurz, et al. 1996). Customarily, operating room temperatures are kept cool for the comfort of the surgical team clad in their head-to-foot attire while working under bright lights. The study investigated the effects of warming up the operating room a few degrees. They found that the increase in temperature resulted in faster wound healing, fewer wound infections, and earlier hospital discharge for the patients. Researchers explained their findings this way: With colder temperatures, the blood vessels to the operative site tend to constrict in order to preserve body temperature. With decreased blood flow, fewer infection-fighting white blood cells were carried to the surgical wound, and this led to more wound infections. With the economics of energy, we can explain the phenomenon this way: with a warmer operating room, the energy usually expended by the patient to keep warm was conserved and could then be directed to wound healing.
Why do we catch more colds and flu in winter months? The Western scientific explanation is that with cold weather, the blood vessels in our noses constrict, and therefore fewer germ-fighting cells and antibodies are available to fight viruses. The Chinese ancients explained colds by attributing them to the Cold evil. Economics of energy could explain the seasonal tendency this way: in cold weather, more of our energy is expended on keeping us warm at the expense of fighting viruses.
Dr. Lai taught that acupuncture redistributes energy but does not increase it. Acupuncture increases blood flow to the diseased area being needled. If the components that promote healing carried in the blood are inadequate, or the overall blood supply is low, acupuncture may not improve the patient’s condition. Patients with inadequate energy need to have their energy replenished with herbs for acupuncture to be effective. In my practice, I found this principle often applied to the elderly who had multiple medical problems. For the same malady, acupuncture might be effective for a young healthy patient but ineffective for a debilitated elderly patient.
A compounding factor in patients with low energy was inadequate protein in the diet, often seen among vegetarians. Dr. Lai advised such patients to gradually reintroduce meat into their diets. He said that a vegetarian diet was adequate to meet the body’s energy demands only if one was leading a monk’s life, with minimal mental and physical stress. He shook his head over Americans who, while living in the horn of plenty, chose to adopt the lifestyle of those living in a third world country.
At an orphanage in Taiwan, a missionary nurse once told me about abandoned children whose bodies were covered with skin sores. In spite of meticulous wound care, the children’s sores did not resolve until they were fed a normal diet adequate in protein. I personally have counseled vegetarian patients to reintroduce meat, fish, or poultry into their diets and have watched such symptoms as rashes resolve without further therapy.
When inordinate demands are placed on the body, it tends to divert energy from one area to another, robbing Peter to pay Paul. May was a woman in her early forties who came to me complaining of chronic intestinal upset, poor digestion, and gassiness. Since Western medications had not worked for her, I decided to use herbal therapy. Over the course of treatment for her intestinal problem, I noticed that May’s face developed a glow. She and her husband had been married for twenty years and were infertile. After so many years, they had accepted the fact that they would be childless. When May told me about her missed period, I tested her for pregnancy, and her test came back positive. She went on to deliver a beautiful baby boy.
May’s case demonstrates the economics of energy. May’s reproductive system was most likely weak to begin with. Her digestive problem diverted energy to the digestive system and away from her reproductive system, robbing it of the needed energy to conceive. When her digestive disorder resolved, her body’s energy was channeled back to the reproductive system. After May’s case, whenever I treated infertility with herbs or acupuncture, instead of focusing obsessively on the fertility issue, I advised patients that the herbs would simply improve their health. If they became pregnant, it would be a bonus. My approach definitely proved less draining for patients both emotionally and financially when compared to fertility clinics, and it often succeeded!
Finding the Ben 
The key to both Eastern and Western medicine is accurate diagnosis. But for TCM, diagnosing the disease is only the first step. The disease is called the Biao 
. It is the external manifestation of the patient’s root problem. Treatment of the Biao, while important, is not enough. The TCM physician needs to determine the Ben, or root problem, the basic imbalance in the patient that caused him to lose his ability to fend off disease in the first place. Interestingly, the Chinese character for Ben is a tree (
) with its roots (
) extending below the surface of the earth. You need to dig below the surface to find the root. If the Ben is not addressed, the condition might not completely resolve. If addressed, the doctor puts the patient’s body “back on its feet,” so to speak. The key to identifying the imbalance is correct diagnosis.
One of my patients, Winnie, returned to work shortly after giving birth to her baby. She developed a recalcitrant, itchy rash. Despite many visits to the dermatologist and multiple applications of various topical steroids, the rash persisted. It would temporarily resolve with the creams, only to return once Winnie stopped applying them. Finally, I treated Winnie using tonifying (enhancing) Blood 
and Kidney Qi 
herbs. According to TCM teaching, these two areas become depleted after a mother gives birth to her baby. With my treatments, the rash completely resolved. For Winnie, the rash was the Biao, the outward manifestation of her condition. The Ben, or root problem, was depleted Blood and Kidney Qi because of her postpartum state and early resumption of work. The phenomenon of postpartum patients developing various new maladies was so common in my practice that there were times I considered labeling it the postpartum syndrome. I have been able to help many other postpartum patients like Winnie who developed different Biao conditions after giving birth.
Tonify the Deficient 
The TCM word “Bu 
” is translated “to tonify.” The word, which has a radical on the left for clothing, actually means “to mend.” In Chinese, if you have a tear in your clothing, you mend it, using this word. If you have a cavity in a tooth, Bu 
is used to mean filling the cavity. If there is a defect in a road, this same word is used to mean repairing the defect. In TCM, when the doctor diagnoses a deficiency, the Chinese word “Bu 
” describes what the doctor prescribes to replenish the deficient entity.
When a bodily function is weak, TCM practitioners call it deficient-organ Qi 
and prescribe herbs to tonify 
or strengthen the function. For instance, if Kidney Qi is deficient 
the Chinese practitioner uses Kidney tonifying herbs 
, which work by improving blood flow to that weakened TCM organ. When other entities, such as blood or other fluids, are deficient, the practitioner will use tonifying herbs to help replenish them.
Regarding tonifying Blood herbs 
, I asked Dr. Lai if they stimulate red blood cell production by the bone marrow, comparable to Erythropoietin, the drug commonly used for anemia caused by chemotherapy. He said that stimulating production might be only one aspect of tonifying Blood. We know that red blood cells have an average life span of 120 days. In addition to stimulating production of new red blood cells, Blood tonifying herbs may rejuvenate old red blood cells to function a bit longer until the newly produced red cells mature.
Tonifying Yin 
fluid is a concept unique to TCM. This process does not simply mean hydration or increasing fluid intake. It involves improving the function of various glands that produce body fluids, such as the mucous, saliva, and digestive glands. The mechanism may be twofold: through dilating the glands’ ducts and through improving blood flow to the glands.
Dr. Lai pointed out that sometimes both Yin and Yang energy can be depleted. If one is more depleted than the other, the patient can appear to have a deficiency in the more depleted one only. In these cases, you have to tonify both Yin and Yang to restore normality. Perhaps this explains why some Chinese patients say they are deficient but cannot tolerate being tonified 
. To them, Bu 
or tonifying herbs are synonymous with Yang tonification 
herbs. When solely Yang tonification 
is used in patients with dual deficiencies, they end up with symptoms of relative Yang excess such as dry mouth and constipation because the need to tonify their Yin deficiency was overlooked.
Fig. 5. Tonifying Yang alone in a dual deficiency leads to relative Yang excess.
Fannie was in her forties when she developed the autoimmune disease Sjogren’s syndrome, characterized by dryness throughout the body. Western medicine’s explanation for Sjogren’s syndrome is that the body inappropriately makes antibodies that attack all its fluid-secreting glands. Fannie had a beautiful singing voice and sang in the church choir. Now, with dry eyes and a dry mouth, she could barely talk. Her digestive juices were diminished, causing poor appetite and constipation.
Her deficiencies were complex. She lacked not only Yin fluid but also Yang function in the form of immune energy. Treatment was tricky. Restoring both Yin and Yang were involved. I referred Fannie to Dr. Lai. In addition to tonifying Yin, her major problem, he also tonified Stomach and Spleen. Her decreased ability to secrete fluids meant Fannie’s digestive tract functioned poorly. On top of that, her weak immune system, which was what led to her body’s attack on its own glands in the first place, needed to be strengthened. Spleen herbs help these two problems, but Spleen herbs tend to be drying. Dr. Lai prescribed a preponderance of Yin tonifying herbs relative to the Spleen herbs. Under his care, her singing voice was restored, and she once again sang in the church choir.
I discovered that the Chinese often have a distorted view of Bu 
. They think that using tonifying herbs will fortify them, even if they are not in a deficient state. My understanding of the concept is that you tonify only where there is a deficiency. Dr. Lai agreed. “You don’t sew a patch on a new suit,” he said. My Chinese patients frequently asked me to recommend a brand of vitamins for them. I used to think their request silly. My usual answer was, “It doesn’t matter, any multivitamin will do. Chances are you might not even need them, but they won’t hurt.” It finally dawned on me that they actually thought vitamins were equivalent to TCM tonifying or Bu herbs. When I told these patients that vitamins are not the same as Bu 
herbs, their eyes would light up as if to say, “Really?” Since then, I made sure to include this bit of information when giving health lectures to Chinese audiences. Many have come up to me afterwards to thank me because that was the first time they heard their misconception explained.
The Herbal Prescription
For years, with the exception of treating serious infection or cancer, Western medicine believed in monotherapy: one drug for one disease whenever possible. For treating hypertension, for instance, you titrate the dosage of one drug and add a second drug only if the condition remains uncontrolled on maximum doses of the first drug. Recently, Western drug therapy has evolved into polypharmacy. This is the usage of multiple drugs to treat one condition in order to get a synergistic effect and minimize side effects. TCM’s approach has always been polypharmacy, using multiple herbs to treat a condition. Dr. Lai taught me to choose three or four herbs from a category that addressed the main condition. These were the major herbs. The other elements of the prescription consisted of herbs to balance the side effects of the major herbs, herbs to enhance absorption, herbs to address any accompanying symptoms, and herbs to correct the imbalances in the host and restore energy.
A typical herb prescription for the common cold or flu consists of cold-cleansing herbs to fight the virus, lowering-Qi herbs to stop coughing, herbs to reduce and break up phlegm, moistening lung Yin herbs to thin secretions, and energy herbs to boost the host’s immunity.
The Confluence of East and West
There were times in the early 1980s when what Dr. Lai said seemed to contradict what I had learned in my Western training. Time proved him right. He told me infections had to be treated with a full course of herbs to guard against future arthritis. At the time, I thought the idea was most likely a holdover from the days before penicillin, when rheumatic fever with its migratory arthritis was a common complication of streptococcal infection. In California, where streptococcal infections are promptly treated with antibiotics, one can hardly find any cases of rheumatic fever. Interestingly though, Western medicine has found links between arthritis and past infections, such as certain infectious diarrhea. It is called “reactive arthritis,” something Dr. Lai described long ago.
Dr. Lai recommended treating stomach ulcers as if they were an infection and told me that stomach ulcers could progress to cancer. At that time, the early 1980s, Western medicine taught that gastric ulcers were either benign or malignant. You rarely worried about a benign ulcer becoming malignant. The standard treatment for stomach ulcers was H-2 blockers such as cimetidine to discourage acid secretion by the stomach. No one felt that ulcers were caused by infections. Now it is an established fact that ulcers are frequently caused by infection with the bacterium H. Pylori, and that there is a link between this bacterium and a form of stomach cancer. Today, if there is evidence of H. Pylori infection in an ulcer patient, we treat with a course of two antibiotics and an agent to discourage stomach acid secretion.
In the early 1990s, I saw a patient who presented atypical symptoms of a heart attack. Her pain was confined to her throat. When I examined her throat, I found it was normal, but her tongue had a thick yellowish coating, which, according to TCM, is a sign of Heat, signifying inflammation or infection. The EKG definitely showed an acute heart attack as the cause of her throat pain. The case was puzzling to me. The patient had a heart attack caused by a blockage of one or more coronary arteries. She had no infection that I could find. Yet using my TCM examination, I found signs suggestive of infection or inflammation. Dr. Lai told me that in his experience, this finding of Heat or inflammation was usual in coronary heart disease. Now, Western studies show that inflammation is an important factor in coronary occlusion and that there is sometimes even a link between coronary occlusion and certain infections such as Chlamydia (Buffon, et al. 2002; Wierzbicki and Hagmeyer 2000). Long ago, Dr. Lai had already linked inflammation with heart disease. The sensitivity of the TCM method in the hands of an astute clinician proved a powerful tool.
While working with Dr. Lai, I sensed that as long as he was available, problems would find a solution. Whenever I stepped into his office, I felt, as did the patients, a sense of security and optimism. Knowing him gave me the courage to embark on my practice of integrating Eastern and Western medicine in the early 1980s, when it was still an unmapped frontier.